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One thing is certain when dentistry moves into the new millennium — the range of dental postgraduate qualifications available in the UK will be greater than ever in the past. This situation contrasts sharply with that prevailing immediately after the second world war when dental postgraduate qualifications were more or less exclusively the universities' Mastership and Doctorate degrees. Within 3 years of the end of that war, however, some radical changes occurred. Dental Faculties were formed within the Royal Colleges (1947 in the Royal College of Surgeons of England) followed by the introduction of their Fellowship (FDS) examinations; and, at almost the same time (1948), the NHS was created (and with it, 'Consultants'). Inevitably, maybe even fortuitously, the introduction of speciality training programmes to prepare for NHS Consultant appointments came able to be linked with the new FDS as a marker of specific stages in that career hierarchy.

It is impossible to consider the evolution of the many new dental postgraduate qualifications which have been introduced since that time other than in the context of changes in the profession. Development and expansion of dental specialities and the proliferation of their professional societies since the early 1950s stimulated the creation of postgraduate qualifications appropriate to their needs. The MCCD and MOrth are typical college-based examples, and the increasing number of taught Masters' degree courses demonstrate the universities' responses. New examinations did not develop per se but as responses to the profession's changing requirements.

A recent such response to change has been the introduction of the MFDS/MFD examination by the three UK-based and the Dublin Royal Colleges to replace the long-standing FDS. This has become the entrance qualification for specialist training and is aimed at those who have undergone 2 years of postgraduate general professional training following graduation. Details of the examination have been described by Dr Paul Callis.1 The need to respond to the profession's requirements in this instance was created by the new pattern of specialist training defined by the Chief Dental Officer's Report in 1995.2 The consequences of this report had profound effects on the training programmes which needed to be completed prior to gaining entry to specialist registers. As had occurred in medicine, the unification of the training grades into a single Specialist Registrar (SpR) grade was accompanied by far more rigid training programmes than hitherto, and introduced considerable extra responsibilities for the trainees' consultants and the postgraduate deans. The fact that the MFDS/MFD is an entry qualification for specialist training highlights that entry is competitive.

However, during the first 30 or so years following the late 1940s, changes in the field of dental postgraduate qualifications did not involve general dental practitioners (GDPs). Although many GDPs had gained the FDS early in their professional lives prior to electing to pursue substantive careers in general practice, and many had undertaken Masterships and Doctorates in topics allied to their special practising interests, a college-based diploma specifically for them was not created until the late 1970s with the introduction of the MGDS. Since then there has been a steady flow of candidates but the uptake could scarcely be described as overwhelming. It rapidly gained academic credibility and was recognised as requiring extremely high standards of clinical accomplishment and patient care: yet, apart from the stimulation of a challenge and the euphoria of gaining something which could not be purchased, good enough reasons in themselves, it offered GDPs no financial benefit. In this it differed from most dental postgraduate qualifications which were more relevant to the salaried services where they were necessary for promotion and, thereby, financial reward by salary increases. Also, at that time, 'competitive entry' was not a feature of general dental practice.

In the late 1970s a notable development in the profession put a different complexion on the issue of postgraduate qualifications for GDPs, namely, the Vocational Training Scheme (VTS). It was the evolution of the VTS through experimental to voluntary and eventually to mandatory status which introduced elements of competitive entry into general dental practice. It is not surprising, perhaps, that the majority of the first VTS Advisers possessed the MGDS because it presented interview panels with peer-reviewed evidence of candidates' professional and clinical standards. Today, not only are posts as Advisers competitive but also, and perhaps more significant, so are more than 600 posts which are advertised annually as VTS Trainers. The process of VTS Trainer selection has introduced a competitive entry element into the lives of substantial numbers of GDPs.

In the light of this changing scenario of general dental practice, the creation of a diploma specifically for GDPs, but which was designed to be attainable after around 2 years of graduate experience, was a priority of the Faculty of General Dental Practitioners (UK) (FGDP (UK)) when it was formed in 1992. To assist candidates in identifying the diploma's requirements, 'goal-posts' were defined when the Faculty produced its educational manual Pathways in Practice. The new diploma which evolved was titled, originally, the DGDPRCS (Eng) but this later became the DGDP (UK).

The former DGDP (UK) examination

The DGDP (UK) was a completely new examination and at the outset the opportunity was taken to involve a professional educationalist, Mr Richard Wakeford, of the University of Cambridge in its design and for guidance through the scientific complexities of various marking-systems. Part 1 consisted of written papers only and which were a Multiple Short Answer paper and a Critical Reading Paper. The latter was a totally novel feature in the field of dental postgraduate examinations although its format had been tried and tested successfully for doctors by the Royal College of General Practitioners' MRCGP diploma. Part 2 consisted of three sections, all of which involved viva voce components; these were a treatment planning exercise, a viva on general issues germane to primary dental care and with particular reference to management in areas such as health and safety, and a viva which was centred around two case-reports of patients who had been treated by the candidate; the reports were submitted prior to the examination. These case-reports formed a basis around which the examiners could explore a candidate's clinical knowledge and patient management.

Entry to the examination was dependent upon the candidate's having attended specified numbers of sessions of postgraduate activity within a given period, and retention of the diploma carried similar requirements annually. This latter requirement was introduced to inculcate the concept that continuing education was for life and not just to prepare for examinations.

All involved in developing this new diploma were conscious that many dental examiners, in both undergraduate and postgraduate sectors, had no formal training in examination theory or techniques. Consequently, all of the newly-appointed examiners underwent an intensive residential training course under the supervision of our professional educationalist adviser. This involved academic discussions about the rationales and designs of examinations as well as practical components which included video-recorded mock viva voce examinations for subsequent self and group analyses. This induction was followed by annual residential courses to update and refresh the examiners' techniques.

Counsellors were appointed nationally to give help and advice to candidates who failed. Records generated at all stages of the examination were exhaustively comprehensive to ensure that the process was transparent. Not only did this help the Counsellors when giving guidance, but also it guaranteed that full details would be available in the event of a candidate's appeal. It was envisaged that normally candidates would take Parts 1 and 2 of the examination at the same diet and the first complete diet of both parts took place in the UK in Spring of 1994. Subsequently, diets have been held also in Hong Kong, Singapore and Malaysia.

The General Dental Council (GDC) approved the diploma as a registered additional qualification. Interestingly, in 1998 the examination became the first college-based dental postgraduate examination to receive a formal visitation by the GDC. The FGDP (UK) was pleased that the GDC's Visitors reported the examination's standards and procedures to be sufficient. In November 1998, the examination was renamed, again with formal approval of the GDC, and is now the MFGDP (UK) Those currently holding the DGDP (UK) may apply to have it changed to the MFGDP (UK). (For information contact: The Faculty of General Dental Practitioners (UK), Royal College of Surgeons of England, 35/43 Lincoln's Inn Fields, London, WC2A 3PN. tel: 0171 312 6671.) A further milestone with the October 1998 diet of the Part 1 was that it became reciprocal with the Part A of the new MFDS/MFD.

MFGDP (UK) and MFDS/MFD reciprocity

For many years it has been recognised that early in their careers many dentists are uncertain which branch of dentistry they would like to follow. There are examples of young graduates deciding, perhaps 3 or 4 years after qualification, that they wish to change their areas of professional interest. Often this has meant their having to go back to square one to take the examinations required for their change in career direction. Clearly, the more flexibility which can be introduced into the qualifications taken in early years, the smoother will be any subsequent career transition. As Dr Callis mentioned, a major and welcome development has been the agreement that the Part A of the MFDS/MFD will be reciprocal with the Part 1 of the new MFGDP (UK).1 During the FGDP (UK)'s discussions with the Royal Colleges, it was decided that some changes would take place in the (new) MFGDP (UK) which makes it slightly different from the format of the DGDP (UK) examination. The changes involve the Part 1 only and will be discussed presently. Part of the agreement is that questions in the Part 1 MFGDP(UK) and Part A MFDS/ MFD will be taken from the question banks of either Examination Board and that interchange of questions will be a feature of both examinations. This is to facilitate the checking of equivalent standards. It should be noted that reciprocity of the MFGDP(UK) and the Part A MFDS/ MFD examinations is valid only for those taking the Part 1 MFGDP(UK) on or after the October 1998 diet.

The new MFGDP(UK) Part 1 Examination

There are three sections to the examination which are undertaken during two sessions each of 2 hours.

The first session consists of twenty multiple short answer questions. Essentially, it is similar to that of the former DGDP(UK) and the topics covered are concerned principally with clinical and management issues relevant to the practice of primary dental care. However, in the MFGDP(UK) some questions will be allied more than previously to the applied basic sciences. It is considered that every dental practitioner should keep up-to-date with relevant current matters and, therefore, in the DGDP(UK) this paper frequently contained questions relating to important contemporary issues (such as controversial dental topics which had become the centre of media attention) or to recent guidelines/directives issued by authorities such as the General Dental Council or Departments of Health. This will remain a feature in the MFGDP(UK). For candidates taking the examination overseas, the fact that their countries' legislations may differ from those of the UK will be taken into consideration as it was with the DGDP (UK).

The second session differs from that of the DGDP (UK) which consisted of only a Critical Reading Paper. It now has two discrete and separately-marked papers:

  • A Multiple Choice Question paper of thirty questions each with five statements which the candidate must identify as true or false. Questions will be directed principally, but not exclusively, to the applied basic sciences. One hour is allocated for this paper.

  • A Critical Reading Paper. This innovative section of the DGDP(UK) is retained but now presents a copy of only one published paper from the scientific literature. The candidate is required to answer questions centred upon evidence-based criteria which test the ability to assess, critically, the various parts of the paper: validity of the selection of control subjects is an example. One hour is allowed for this paper.

The requirements for entry and retention of the MFGDP (UK) remain the same as they were with the DGDP (UK).

Consequently, the only difference between the MFGDP (UK) Part 1 and the MFDS/MFD Part A is that the latter has a Simulated Clinical Examination whereas the former has a Critical Reading Paper. As mentioned, the Part 2 of the MFGDP(UK) examination will be no different from the Part 2 of the DGDP(UK). The initial training and regular updating of examiners will be as essential an element with the MFGDP (UK) as it was with its predecessor. The formats of the Part 1 MFGDP and Part A MFDS/MD examinations are shown in Table 1.

Table 1 Table 1
Full size table

A difference between the MFGDP (UK) and the MFDS/MD examinations is that although all parts of each examination (Parts 1 and 2 of the MFGDP (UK) and Parts A, B and C of the MFDS/MD) may be taken within the same diet, candidates for the MFGDP(UK) can do this if their clinical experience is solely in general dental practice. Candidates for the MFDS/ MD, however, must first have gained clinical experience in approved posts in more than one discipline which can include vocational training in general dental practice. This means that since the vast majority of graduates enter, and stay in, general dental practice they can gain the MFGDP(UK) without the need to undertake any non-GDP posts yet it offers the very small minority who decide to leave general dental practice to embark upon hospital-based careers the advantage of an already-gained Part A MFDS/MFD.

Conclusion

In this paper I have traced the development of the new MFGDP (UK) in the context of the evolution of dental postgraduate qualifications in response to the profession's needs and how, with its close links with the new MFDS/MFD, it has responded to the needs of GDPs in today's rapidly changing world of practice.

Often, GDPs ask why they should bother with any further examinations when they offer no apparent tangible gain. I feel that there are two reasons. First, as mentioned earlier, competitive situations are developing in general dental practice: for example, currently, a postgraduate qualification is not required to be a VTS Trainer but common sense dictates that, all other things being equal, the applicant in a competitive interview who has a postgraduate qualification is in a pole position compared with those who have not. Second, it is not so much a question of what one gains from embarking upon postgraduate diplomas when already working extremely hard as a busy GDP, but rather what one avoids. Attending courses, meeting regularly with colleagues at study groups and having goals are all factors known to help in averting professional burn-out.